1. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 1 of 12 2 MINUTE PEARLS Documenting the -25 Modifier In Primary Care Do you sometimes see patients for wellness visits and end up addressing separate acute issues during the same encounter? In these situations, it is appropriate to document a -25 modifier in the AHLTA Disposition Page Why should you care? Using the -25 modifier (used when there are two separate and distinct E&M codes for a single visit) enables you to get RVU credit for both E&M codes. –For example, a well woman exam for a 30 year old established patient (99395) yields 1.36 RVU whereas a visit for evaluation and treatment of a moderately severe headache might result in a 99213 (0.67 RVU). Using the -25 modifier enables you to get credit for BOTH E&M codes and would result in 2.03 RVU for that visit. Always consult your local coder for guidance should you have any questions.

2. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 2 of 12 Important Considerations You can only use the -25 modifier in this situation if you do a complete wellness type visit in addition to the extra history and physical documentation required for the acute problem. The top diagnosis in the A/P window must be a V-code for the preventive care provided.

3. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 3 of 12 Ordering Multiple Diagnoses You MUST always place the preventive medicine diagnosis code first (also known as the V code) in the A/P module. Any acute or other diagnoses should be listed subsequently.

4. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 4 of 12 Using Disposition Module 2) Select Prev Med Eval/Mgt (Preventive Medicine Evaluation and Management) as the Service Type 1) Go to Disposition Page

5. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 5 of 12 Selecting Additional E&M Coding 3) Select Additional E&M Coding Tab

6. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 6 of 12 Associating Diagnoses to proper E&M Code 4) Under E&M Code 1, check the Preventive Medicine diagnosis (visit for: routine adult HP) and deselect the acute diagnosis (Tension Type Headache)

7. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 7 of 12 Associating Diagnoses to proper E&M Code 5) Under E&M Code 2, check the acute diagnosis (Tension Type Headache) and deselect the Preventive Medicine diagnosis (visit for: routine adult HP)

8. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 8 of 12 Selecting 2 nd E&M Code Type 6)Select this button (…) to bring up the Selection Menu above 7) From the E&M Category drop down menu, select Office/Outpatient Visit

9. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 9 of 12 Selecting 2 nd E&M Code Type 8) Select the appropriate E&M code using the description to assist in determining correct code (or consult with local coder)

10. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 10 of 12 Selecting -25 Modifier 9) Select the Modifier drop-down menu and select number 25 (SIGNIFICANT, SEPARATE E&M SVC BY SAME PHYSICIAN)

11. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 11 of 12 Completing Disposition Module 10) You have successfully documented the 25 modifier and received credit for both E&M codes! Now select Sign to complete the note.

12. 2 Minute Pearls AHLTA Disposition Module: Coding the -25 Modifier 12 of 12 For More Information… AMEDD AHLTA Homepage –https://www.us.army.mil/suite/page/406 (AKO password required)https://www.us.army.mil/suite/page/406 AHLTA Video Tutorials –http://www-nmcp.mar.med.navy.mil/AHLTA/AHLTA%20Training%20Tools/index.htmlhttp://www-nmcp.mar.med.navy.mil/AHLTA/AHLTA%20Training%20Tools/index.html I would appreciate any feedback or suggestions you have for future AHLTA 2 Minute Pearls. Please contact me at the following: MAJ Mark Stackle, MD (AHLTA Program Office) Email: mark.stackle@us.army.milmark.stackle@us.army.mil ****(If you would like to receive future versions of the AHLTA 2 Minute Pearls directly, please email Lakia Brockenberry at Lakia.Brockenberry@us.army.mil to be added to the distribution list)Lakia.Brockenberry@us.army.mil